Barriers and opportunities for evidence-based health service planning: the example of developing a Decision Analytic Model to plan services for sexually transmitted infections in the UK

Decision Analytic Models (DAMs) are established means of evidence-synthesis to differentiate between health interventions. They have mainly been used to inform clinical decisions and health technology assessment at the national level, yet could also inform local health service planning. For this, a DAM must take into account the needs of the local population, but also the needs of those planning its services. Drawing on our experiences from stakeholder consultations, where we presented the potential utility of a DAM for planning local health services for sexually transmitted infections (STIs) in the UK, and the evidence it could use to inform decisions regarding different combinations of service provision, in terms of their costs, cost-effectiveness, and public health outcomes, we discuss the barriers perceived by stakeholders to the use of DAMs to inform service planning for local populations, including (1) a tension between individual and population perspectives; (2) reductionism; and (3) a lack of transparency regarding models, their assumptions, and the motivations of those generating models

ReseArch with Patient and Public invOlvement: a RealisT evaluation - the RAPPORT study

Background Patient and public involvement (PPI) is a prerequisite for many funding bodies and NHS research ethics approval. PPI in research is defined as research carried out with or by the public rather than to, about or for them. While the benefits of PPI have been widely discussed, there is a lack of evidence on the impact and outcomes of PPI in research. Objectives To determine the types of PPI in funded research, describe key processes, analyse the contextual and temporal dynamics of PPI and explore the experience of PPI in research for all those involved. Mechanisms contributing to the routine incorporation of PPI in the research process were assessed, the impact of PPI on research processes and outcomes evaluated, and barriers and enablers to effective PPI identified. Design A three-staged realist evaluation drawing on Normalisation Process Theory to understand how far PPI was embedded within health-care research in six areas: diabetes mellitus, arthritis, cystic fibrosis, dementia, public health and learning disabilities. The first two stages comprised a scoping exercise and online survey to chief investigators to assess current PPI activity. The third stage consisted of case studies tracked over 18 months through interviews and document analysis. The research was conducted in four regions of England. Participants Non-commercial studies currently running or completed within the previous 2 years eligible for adoption on the UK Clinical Research Network portfolio. A total of 129 case study participants included researchers and PPI representatives from 22 research studies, and representatives from funding bodies and PPI networks

Disseminating technology in global surgery.

BACKGROUND:Effective dissemination of technology in global surgery is vital to realize universal health coverage by 2030. Challenges include a lack of human resource, infrastructure and finance. Understanding these challenges, and exploring opportunities and solutions to overcome them, are essential to improve global surgical care. METHODS:This review focuses on technologies and medical devices aimed at improving surgical care and training in low- and middle-income countries. The key considerations in the development of new technologies are described, along with strategies for evaluation and wider dissemination. Notable examples of where the dissemination of a new surgical technology has achieved impact are included. RESULTS:Employing the principles of frugal and responsible innovation, and aligning evaluation and development to high scientific standards help overcome some of the challenges in disseminating technology in global surgery. Exemplars of effective dissemination include low-cost laparoscopes, gasless laparoscopic techniques and innovative training programmes for laparoscopic surgery; low-cost and versatile external fixation devices for fractures; the LifeBox pulse oximeter project; and the use of immersive technologies in simulation, training and surgical care delivery. CONCLUSION:Core strategies to facilitate technology dissemination in global surgery include leveraging international funding, interdisciplinary collaboration involving all key stakeholders, and frugal scientific design, development and evaluation

Realizing Improved Patient Care Through Human-Centered Design in the Operating Room, Volume 2

This 4-year grant from the Agency for Healthcare Research and Quality supports the development of a learning lab focused on designing a safer, more ergonomic operating room. Sponsor: Agency for Healthcare Research Quality Project period: 9/1/15 to 8/31/19 Project Description: The overarching goal of the learning lab titled, “Realizing Improved Patient Care through Human-Centered Design in the Operating Room (RIPCHD.OR) is to develop an evidence-based framework and methodology for the design and operation of operating rooms such that it impacts improved perioperative outcomes including surgical site infections, surgical errors and staff injuries

Realizing Improved Patient Care Through Human-Centered Design in the Operating Room, Volume 3-4

This 4-year grant from the Agency for Healthcare Research and Quality supports the development of a learning lab focused on designing a safer, more ergonomic operating room. Sponsor: Agency for Healthcare Research Quality Project period: 9/1/15 to 8/31/19 Project Description: The overarching goal of the learning lab titled, “Realizing Improved Patient Care through Human-Centered Design in the Operating Room (RIPCHD.OR) is to develop an evidence-based framework and methodology for the design and operation of operating rooms such that it impacts improved perioperative outcomes including surgical site infections, surgical errors and staff injuries

The Ambulatory Care Center Design Tool (ACCDT)

Overview This Ambulatory Care Center Design Tool (ACCDT), developed by Dr. Anjali Joseph and Dr. Zahra Zamani from Clemson University in collaboration with The Center for Health Design (CHD), builds upon a series of papers, best practice case studies and in-depth literature reviews conducted by CHD as well as CHD\u27s Clinic Design Post-Occupancy Evaluation Toolkit – Tool 2 Audit of Physical Environment with additions from a thesis by Crews (2013). The tool supports design teams in making key design decisions about ambulatory care centers linked to evidence based design goals and principles. Detail The tool is organized around three main spatial categories: 1. Building exterior, 2. Building interior, and 3. Community spaces. The interior space is sub-divided into two main divisions: 2.1 Spaces for patients and 2.2 Clinicians. Spaces for patients include check-in and waiting areas as well as check-out. Clinicians have separate access to staff spaces. Clinicians and patient share the a) patient-clinician interaction and b) POD spaces. Circulation is shared between all spaces. A set of 13 design goals that are critical for the design of the ambulatory care centers have been identified based on previously conducted literature reviews and case studies that include: privacy, collaboration, access, wayfinding, communication, experienced-based care, comprehensive care, safety, security, flow, technology, sustainability, and flexibility. These goals support most models of care such as patient centered-medical home, patient-centered care, etc. However, these goals are not meant to be exhaustive. The tool provides design features that can be prioritized based on the goals, agreements, limitations, or decisions of the design team. Designers may add new design features based on their own literature review and research/practice experience. There may be instances of trade-offs between design goals

Realizing Improved Patient Care Through Human-Centered Design in the Operating Room, Volume 1

This 4-year grant from the Agency for Healthcare Research and Quality supports the development of a learning lab focused on designing a safer, more ergonomic operating room. Sponsor: Agency Agency for Healthcare Research Quality Project period: 9/1/15 to 8/31/19 Project Description: The overarching goal of the learning lab titled “Realizing Improved Patient Care through Human-Centered Design in the Operating Room (RIPCHD.OR) is to develop an evidence-based framework and methodology for the design and operation of operating rooms such that it impacts improved perioperative outcomes including surgical site infections, surgical errors and staff injuries

Safe OR Design Tool - A Web Interface to Explore Strategies and Desired Outcomes for Design Elements in Operating Rooms

The Safe OR Design Tool is grounded in the work that has been conducted as part of an Agency for Healthcare Research and Quality (AHRQ) funded Patient Safety Learning Lab (PSLL) titled Realizing Improved Patient Care through Human-Centered Design in the Operating Room (RIPCHD.OR).The tool provides an opportunity to interact with components in an OR environment through a 3D model. The web interface also allows users to explore design strategies and their associated desired outcomes for a series of design elements commonly found in OR environments. Additionally, users of the tool may filter design strategies by type and access citations associated with each design strategy. This tool can also support multiple stakeholders in understanding how the built environment can be leveraged to increase safety in the OR